Benjamin Tighe explores the cost of periodontal disease, considering not only the financial implications at various stages of development but also how it affects sufferers’ quality of life.
Following the Hygienist Advisory Panel (HAP) last year, Johnson and Johnson Ltd, the makers of Listerine, followed up with four members of the group to talk more about key issues affecting dental hygienists and dental therapists
For this, each of these four – Benjamin Tighe, Laura Bailey, Alison Edisbury and Anna Middleton – will be exploring important topics to shine a light on the challenges and offer support for both dental professionals and patients, including:
- Oral health – is there a need for a change in ethos?
- Exploring the patient-friendly consensus
- The association between inflammatory-driven diseases.
Here, in an exclusive interview, Benjamin Tighe explores the cost of periodontal disease from a dental hygiene/therapy perspective, taking into consideration not only the financial implications of treating periodontal disease at various stages of development but also how it affects sufferers’ quality of life, on a physical health level and emotionally.
Evidence-based mouthwash use supported by Hygienist Advisory Panel consensus
When Johnson and Johnson Ltd. brought together a group of dental hygienists and therapists for the very first Hygienist Advisory Panel meeting, they shared their views in relation to plaque management.
They also explored the benefits and any limitations of mechanical cleaning, as well as possible adjunctive support in the form of a chemotherapeutic mouthwash.
Building on the outcomes of the earlier National Advisory Panel formed of key opinion leaders, the group agreed on the following consensus:
‘Healthy gums don’t bleed when brushed. Twice daily brushing along the gum line and cleaning in between the teeth is essential to support a healthy mouth. Fluoride mouthwashes clinically proven to reduce germs (plaque) offer additional benefit.’
Below the age of 7
‘Spit don’t rinse.’Over the age of 7
‘For better gum health, after brushing spit and then rinse with a fluoride mouthwash that is clinically proven to reduce germs (plaque).’For more information, visit www.listerineprofessional.co.uk
What struck you the most after reading the Economist’s White Paper?
Benjamin: After reading The Economist’s White Paper, I think the most shocking takeaway was that there are more years lost to disability from periodontitis than any other disease.
Also, that it’s now classed as being a social disease due to the prevalence being clustered in socioeconomically deprived areas. I’ve always known that, but when you see it in a paper it hits home. I’ve personally delivered treatment for free, in my own time, as I’ve known the patient is unable to pay for it. That’s sad.
How have you taken that information on board as a practising dental professional?
Benjamin: It’s a difficult one. I’m privileged enough to work in an affluent area. But I’m aware of the difficulties in accessing treatment and the costs of treatment across the country.
My background is education, so, for me, it all comes back to prevention. Getting out there, into communities, schools, health centres, and providing the tips, tools and techniques to achieve and maintain a healthy mouth.
I’ve also been spending a lot more time with patients discussing the impact plaque biofilm has on their overall health and making a lot more referrals to their GPs for things like diabetes, menopause, and blood pressure. A patient has even said, “Wow, you’re so much more than a hygienist.”
You obviously see first-hand the personal costs of perio disease. What do you tend to see and how do you help patients overcome them?
Benjamin: The first-hand personal costs of periodontal disease, sadly, is usually a lot of shame and embarrassment.
Biggest achievement
When new patients come to see me, they usually spend the first few minutes apologising for the state of their mouth and explaining how it got that way.
To me, their biggest achievement is that they’ve made it to my chair. The past is the past, it’s about how we work together as a team and how we get them back to health. My role as a hygienist isn’t just to ‘clean’ your teeth.
We’re here to encourage and support you to reach your goals – which is ultimately health and confidence driven. If you understand why you need to do something, you’re more likely to do it.
It’s common, due to time constraints, for clinicians to just tell the patient what to do and hope they do it. But I’ve found sitting down with the patient and explaining the rationale behind your advice yields far superior results.
Given the evidence base, at what stage should periodontal disease be addressed and why?
Benjamin: Personally, I would like to see perio disease addressed at the stage of health. By that I mean ensuring patients never develop disease. Educating the patient to the consequences of not looking after their own mouth and seeing us (hygienists) regularly would help prevent any disease forming in the first place.
It’s cheaper for the patient in the long run and better for their overall health. However, I know that probably isn’t realistic. The Economist’s White Paper suggests intervening at gingivitis is best.
This is when the disease is reversible. There hasn’t been any long-term structural damage to the supporting bone.
Have you changed your position on this at any point?
Benjamin: Bleeding in the mouth should never happen but it seems to have become normalised. I often hear people say, ‘My gums have aways bled’. We need to move away from this, it’s not okay and it’s your body telling you something is wrong. If patients are aware of the signs from the start and know when they see bleeding they need professional help, we can intervene and prevent it getting worse.
How do you think using the HAP consensus can help?
Benjamin: When we consider the consensus from the Hygienist Advisory Panel, I think its main benefit comes back to education. The HAP is a little more patient focused. Receiving and following advice can sometimes be overwhelming for patients.
I’ve seen first-hand the confusion on patients’ faces when you give them a lot of instructions, so it’s about simplifying the message. The emphasis is still on the mechanical plaque removal, but we’re saying that using a fluoride mouthwash that reduces plaque offers additional benefit. Who doesn’t want additional benefits?
What constitutes success for you when providing ongoing and long-term perio care for a patient?
Benjamin: When providing ongoing and long-term periodontal care, for me success comes down to stability. Once the patient is deemed healthy or stable, the patient and I work together as a team to ensure that doesn’t change.
I obviously want the patient to be happy, to understand my advice and achieve the goals set. If we achieve all of that then the treatment has been successful.
Has adding a mouthwash to mechanical cleaning helped with plaque control outcomes? What have you experienced in practice in those terms?
Benjamin: Adding a mouthwash to mechanical cleaning has genuinely helped with plaque control outcomes. Historically, I’ve always been anti mouth rinse.
From university, we were told that mouth rinse removes all the fluoride in toothpaste. I think that is the reason why so many hygienists are reluctant to recommend it.
But, since Professor Chapple presented the evidence at the Johnson and Johnson HAP, I’ve been selectively advising its use and been surprised with the results. It does seem to be helping reduce plaque levels and keeping the tongue cleaner.
There are definitely chemical qualities that help reduce plaque, but it also serves as a nice reminder for the patient to think about their mouth.
What would you like to see change in the next few years to reflect those challenges both dental professionals and patients are experiencing in the current climate in terms of perio disease?
Benjamin: In the future I would like to see more public health funding. We have to thank brands for educating the patients, they’ve done a brilliant job, but it would be nice to see more of the profession delivering the advice. I think it might make us more approachable and, hopefully, break down some barriers.
Also, more education and interdisciplinary working – I’ve seen first-hand the difference it can make to patients when I’ve liaised directly with consultants, doctors and nurses. We put the mouth back into the body and start to look at the patient as a whole.
Finally, easier access to treatment for patients and more clinical freedom for us as dental hygienists and therapists. Under the NHS it can be more challenging but in the private sector we’re able to work autonomously and deliver a high standard of care with fewer time constraints.
